It appears that the Health Care bill has passed the house. Now, it will be introduced to the Senate for further debate.
KTAR.com – House passes health care bill on close vote Saturday, Nov 7 2009
Health Care Reform and Health Plans and Insurance Health Care, Health Plan, health reform, Insurance 10:42 pm
New Trick by the Health Insurance Industry Tuesday, Nov 3 2009
Health Care Reform and Health Plans and Insurance and Preventive Medicine Coding and Reimbursement Billing, Coding, Health Care Reimbursement, Health Plan, health reform, Insurance, insurance reimbursement, physicals, preventive medicine, Reimbursement 8:39 pm
Imagine that you are an independent contractor for a company that pays you a specific rate for a specified amount of work; however, if you do more than the specified amount of work you would receive an additional amount. Now, if you were to do that additional amount of work separately you would receive 100 dollars. But, if you do that additional amount of on the same day as your normal work load, you would receive your normal pay for your normal work load and 50 dollars for the additional amount of work. Would that be acceptable to you?
To illustrate further, I do my work and earn $100. Tomorrow, I fill in for someone else and do their work and earn $100. Okay, that seems fair. Tomorrow, I not only do I do my job, but I also completely do someone else’s work. As an independent contractor, should I receive $100 for my normal work and that’s it? Should I receive $200 for a double workload? How about if I only get $150…$100 for my work and $50 for completing someone else’s job? I think many of us would say that I should receive $200!
Unfortunately, many physicians are experiencing the $150 example from health plans when it comes to providing medical care on the same day as a preventive medicine visit. According to universal coding principles, it is expected that a physician will code an evaluation and management (Office Visit) for diagnostic (medical) issues when done on the same day as a preventive medicine (complete physical). One of the primary reasons is so insurance companies do not have to reimburse for services outside their reimbursement policies; for example, if the patient does not have preventive medicine benefits but comes in for a physical, the physical can not be coded as a covered medical benefit just to get paid.
In physician coding, we are trained to code all services accurately to represent what actually was performed and documented so as to not open the practice up to the risk of fraud and abuse allegations. In theory, one would think that if there is a universal coding policy, then the service should be reimbursed in a consistent manner; however, this is not the case. What we are seeing is that the majority of health plans will pay the problem visit at 50% and the physical at 100% (there’s your $150!). A few others will not reimburse the problem visit at all on the same day as the physical (you only get $100…double the work at the pay of one job!). Consequently, many physicians are telling patients that they cannot have both services performed on the same day, thus the physician is able to get full reimbursement for each service (aha! that’s where I put my $200!).
It is inconvenient to the patient to make two appointments; but with the increasing expenses that physician’s practices are having to absorb, it is just not possible to throw away all or half of a reimbursement. In addition, it is inconvenient to other patients who are not able to get in to be seen because of the physician’s full schedules…or doing in two visits that which he can do in one. Understandably so! The physician should be reimbursed for all of his services fairly. This will allow the physician to be able see additional patients who require medical attention and not play insurance games!
FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule Friday, Oct 30 2009
Uncategorized 3:36 pm
For Release: 10/30/2009
http://www.ftc.gov/opa/2009/10/redflags.shtm
FTC Extends Enforcement Deadline for Identity Theft Red Flags Rule
At the request of Members of Congress, the Federal Trade Commission is delaying enforcement of the “Red Flags” Rule until June 1, 2010, for financial institutions and creditors subject to enforcement by the FTC.
The Rule was promulgated under the Fair and Accurate Credit Transactions Act, in which Congress directed the Commission and other agencies to develop regulations requiring “creditors” and “financial institutions” to address the risk of identity theft. The resulting Red Flags Rule requires all such entities that have “covered accounts” to develop and implement written identity theft prevention programs to help identify, detect, and respond to patterns, practices, or specific activities – known as “red flags” – that could indicate identity theft.
The Commission previously delayed the enforcement of the Rule for entities under its jurisdiction until November 1, 2009. The Commission staff has continued to provide guidance to entities within its jurisdiction, both through materials posted on the dedicated Red Flags Rule Web site (www.ftc.gov/redflagsrule), and in speeches and participation in seminars, conferences and other training events to numerous groups. The Commission also published a compliance guide for business, and created a template that enables low risk entities to create an identity theft program with an easy-to-use online form. FTC staff has published numerous general and industry-specific articles, released a video explaining the Rule, and continues to respond to inquiries from the public. To assist further with compliance, FTC staff has worked with a number of trade associations that have chosen to develop model policies or specialized guidance for their members.
On October 30, 2009, the U.S. District Court for the District of Columbia ruled that the FTC may not apply the Red Flags Rule to attorneys. Today’s announcement that the Commission will delay enforcement of the Rule until June 1, 2010, does not affect the separate timeline of that proceeding and any possible appeals. Nor does it affect other federal agencies’ ongoing enforcement for financial institutions and creditors subject to their oversight.
The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,700 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of consumer topics.
- MEDIA CONTACT:
- Office of Public Affairs
202-326-2180
(Red Flags October 09)
RED FLAGS RULE: Resources available Saturday, Oct 3 2009
Compliance Compliance, identity theft, red flag rule 10:19 am
The Red Flags Rule became effective November 1, 2008; however, the actual enforcement date has been delayed several times resulting in the current enforcement date of November 1, 2009. Several professional organizations are “negotiating” with the Federal government in the attempt of trying to exempt physicians in the definition of “creditors”. The Federal Trade Commission states that the extra grace period is “to give creditors and financial institutions more time to develop and implement written identity theft prevention programs.” Penalties for not complying with the Red Flags Rule are $3,500 per incident under Fair Credit Reporting.
The information provided below has been developed for small businesses who are considred “low-risk” to comply with the Red Flags Rule. The following is an excerpt from the Federal Trade Commission website:
COMPLYING WITH THE RED FLAGS RULE:
Do-It-Yourself Program for Businesses at Low Risk For Identity Theft
The Red Flags Rule requires many businesses and organizations to implement a written Identity Theft Prevention Program to detect the warning signs – or “red flags” – of identity theft. By identifying red flags, you’ll be in a better position to spot an imposter trying to defraud you by using someone else’s identity to get products and services.
As a practical matter, most businesses and organizations that provide products and services to their customers and then bill them later are covered by the Rule. To find out if the Rule applies to you, read Fighting Fraud with the Red Flags Rule: A How-To Guide for Business.
The Red Flags Rule gives you the flexibility to design an Identity Theft Prevention Program appropriate for your business, given its size and potential risk for identity theft. While some companies need a comprehensive Program, businesses and organizations at low risk for identity theft may find that a streamlined Program fits the bill. If you’re at low risk for identity theft, this do-it-yourself Program may be sufficient. http://www2.ftc.gov/bcp/edu/microsites/redflagsrule/get-started.shtm
This streamlined program seems to be the easiest and most straightforward way to implement the RFR policy in most physician’s practices.
Some helpful resources provided by professional organizations are as follows:
American Medical Association (AMA) http://www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml .
Medical Group Manager’s Association (MGMA) RFR Resource Center at http://www.mgma.com/policy/default.aspx?id=22932 .
Modern Medicine article: http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=592249&sk=67a9e20fc29c2e9eeddb4f43bc9d04ff
Federal Register, November 9, 2007: ”Interagency Guidelines on Identity Theft Detection, Prevention, and Mitigation” http://ftc.gov/os/fedreg/2007/november/071109redflags.pdf
Woman charged extra for asking doctor too many questions Saturday, Aug 8 2009
Health Plans and Insurance and Preventive Medicine Coding and Reimbursement well woman exam, pap, preventive medicine, physicals, Well-Woman, Health Care Reimbursement, Reimbursement, Insurance, Health Plan, physician, insurance reimbursement, patient, Coding, Billing, Physician Practice 8:43 pm
Woman charged extra for asking doctor too many questions | 3 ON YOUR SIDE |
Arizona | azfamily.com
by Gary Harper/3 On Your Side
August 5, 2009
A Valley woman says she has a billing problem with her doctor’s office.
The billing problem has to do with a “well woman exam,” basically it is an annual physical for women.
The woman you are about to meet says it was supposed to be covered 100% by her insurance carrier, so why does she keep getting billed by the doctor’s office?
Shannon Karal, like a lot of women, knows the importance of having an annual physical. She says, “I do all my preventative visits for dentist, doctor, any of the normal things I try to go as much as they say you should go.”
So Shannon scheduled a well woman exam at a physician’s office called Doctors Goodman and Partridge, an exam she says that is 100% covered by her insurance carrier. Shannon explains, “I just had some questions and concerns about normal things that a young woman like me would have.”
Shannon says the exam was completely paid for by her insurance, however, she keeps getting a bill for $92 from the doctor’s office so, she called to find out why and, according to Shannon, she was told she asked too many questions during her exam.
She admits, “It makes me feel like next time I go to the doctor I shouldn’t share any of my questions or concerns or take any more time out of their day because I might be charged extra for that.”
Shannon maintains the questions she asked during her exam were all normal “female-related” questions and she cannot believe she would be charged. “I would completely understand this extra charge if there was another test done or something they do for my questions. But nothing! It was all verbal.”
The office of Doctors Goodman and Partridge would not talk to 3 On Your Side about Shannon’s case citing privacy issues but after our inquiry, they sent Shannon a letter saying, “The problems evaluated and managed at that visit were above and beyond the scope of a normal well woman exam” but, Shannon says that is nonsense and feels she is being billed for asking too many female-related questions, and taking up too much of the doctor’s time. Shannon tells 3TV, “I feel like there’s a stop watch every time I go to the doctor and they’re gonna be timing me and making sure I don’t go over that time and if I do then ‘Oh, there might be an additional charge for this.’”
Americans on Healthcare Reform: Top 10 Takeaways Saturday, Aug 8 2009
Health Care Reform and Health Plans and Insurance Health Care, Health Care Reimbursement, Health Plan, health reform, Insurance, insurance reimbursement, Reimbursement 7:52 pm
Side-by-Side Comparison of Major Health Care Reform Proposals – Kaiser Family Foundation Saturday, Aug 8 2009
Health Care Reform and Health Plans and Insurance Health Care, Health Care Reimbursement, health reform, Insurance, insurance reimbursement 5:12 pm
This is a useful resource if you are interested in comparing all the proposals and/or specific topics.
Side-by-Side Comparison of Major Health Care Reform Proposals – Kaiser Family Foundation
Achieving comprehensive health reform has emerged as a leading priority of the President and Congress. President Obama has outlined eight principles for health reform, seeking to address not only the 45 million people who lack health insurance, but also rising health care costs and lack of quality. In Congress, a number of comprehensive reform proposals have been announced as the debate proceeds over how to overhaul the health care system.
Sorry I am behind Wednesday, Aug 5 2009
Uncategorized Life, Sorry, Vacation 9:46 pm
I am sorry that I haven’t updated my blog in a month. I have been extremely busy with work and went on vacation. So, those who have taken vacation realize that you spend the two weeks prior to vacation trying to tie up loose ends and, possibly, even try to get a little ahead of yourself in hopes that things won’t be so bad while you are out and when you return. Then, you return from a one week vacation and it takes two weeks to catch up. It’s crazy!
Anyhow, we had a wonderful time on vacation in San Diego. The temperatures were awesome. The ocean was fun! Vacations go way too fast, don’t they!?!
Allow me an opportunity to catch up a little more and I will be back. I am trying to figure out what I want to blog about next.
Helped Patient Battle Health Plan and Won! Sunday, Jul 5 2009
Health Plans and Insurance and Reimbursement Billing, Health Plan, Insurance, insurance reimbursement, patient, Physician Practice 9:36 pm
Just about a week ago, I received a call from a patient who was extremely upset that she was being billed $1,400.00 by the imaging facility for a CT scan after we told her that she did not need a prior authorization from her insurance company. Typically, this is one of those things that it’s our word against the insurance company and, historically, the insurance company seems to always win. I guess the axiom “he who holds the money has the power” applies in this kind of situation. The insurance company insisted that they did not have a record of our phone call to them and that they would never have told us that this patient did not need a prior authorization for the CT scan. The patient was irate and understandably so…especially with the economy the way it is. As a goodwill gesture and to keep peace with the patient, I would have accepted the responsibility and paid for the scan and our office would be out the money.
But…we voice record all our incoming and outgoing telephone calls using a system called Talkument. I have all of the staff and physicians trained on what information is helpful to me when I need to investigate a telephone conversation. In this case, I pulled the patient’s chart and the medical assistant wrote a note stating that she called the health plan on 5/23/09 at 3:13 pm and found out that no prior authorization was needed and that she talked with Ann. I knew my medical assistant’s extension and searched based on the information that I had, and viola, I found the four minute telephone conversation between my medical assistant and the health plan representative, Ann, who said that the patient did not need a prior authorization for the CT scan!
I had a three way conference call between the patient, myself and the health plan where I played the recording for them. The patient was ecstatic! I had to play this information a couple of levels up the ladder and was still told that someone would have to get back to me (quite frankly, I don’t think they were ready to address the fact that the doctor’s office actually had recorded them! Uh oh! They were caught!)
About a week later, the health plan representative called me and stated that they would cover the cost of this CT scan “this one time”. She still did not want to take responsibility for her company giving inaccurate information. She made it sound like we doctored up the recording…even though we have caller ID that had the health plan’s toll-free number and the first two minutes of the recording was the automated system that announces the health plan name. I was even told by the rep that the person with whom my medical assistant had talked with, Ann, was not an employee of this health plan. I love the lack of accountability!
Defensive medicine is taking on a new definition. Besides the Internet, the next best resource I have in my office is the voice documentation system for phone call recording! The system has aided me with staffing issues, patient issues and now insurance issues. It has definitely paid for itself in protecting my physicians and our office from lying and deceit.
7 Ways Health Reform Is Going to Affect You Thursday, Jun 11 2009
Health Care Reform Health Care Reimbursement, health reform 5:48 pm
U.S. News & World Report article
7 Ways Health Reform Is Going to Affect You
